Post traumatic fractures involving the lower extremity are often difficult to manage because of the limited options for soft tissue coverage and the increased susceptibility for infection to ensue. One particular anatomic landmark that poses such difficulties is the distal tibia. Currently, there is very limited literature regarding a universal treatment protocol and outcomes related to such defects. This review focuses on some of the promising methods used to describe and define a systematic orthoplastic approach towards diagnosing, managing and treating both osseous and soft tissue defects involved with post traumatic distal tibial fractures.